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Home My WebLink About4309-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4309 Z Permission is hereby granted to: .................. ~wa~d..~l~l.~ ........................ to ........... $t,~3,~ · · 1~m,ta~l a ..1~1,;~1~ ....................................................................................... ......................................... ~"~"~7~ .............................................................................................. at premises located at ............. JJ~....JJ~J~ll.. ~$ ................................................................... ................................................... tl~t,t~'t~l~' ......... N.,'Z-~ .................................................................... pursuan¢ to application dated ................................ Jl~.....~j~ .......... , 19....69 ond opproved by the Building Inspector, Fee $.....JSjQO ....... ' '- Buil~ling I~;pector ! BUll. DING DII~AIITMENT TOWN CLE~K~ 01~1¢! ~OUTHOLD, N. Y. Approved ........................................ , 19 ........ permit No ................ Disapproved a/c ..... :...~ ...... : ..................... ~ ............. ....... i---'-"--'"'"'-'""r)Bulldlng In~ ' ""' Application No .............. ~.. ............. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plo. t .pi.an sho. win~ I.oc.atio~. of lot ?.nd of buildings on premises, relationship to adjoining premiees or public streets or areas, ana g~v~ng a amauea ar~cr,ption of layout at pragerty must be ~awn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will Issue a Building Permit to the applicant. Such permit shall he kept on the premises available for inspection throughout the pragrms of the work. e. No building shall he occupied or used in whole or In part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~Buitd!ng Zone. Or.dinance of the Town of South01d, Suffolk C. ounty, New York, and other applicable Laws, Ordinances or Kegu~ations, rot the construction of buildings, additions or alterations, or for removal or demolition, as herein dascr bed The applica n, ag rees to comply with all applicable laws, ordin~..~ng;,'~ t:::~AJ~r~ ~°d~tc~!~and~././f~' regulations. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................................................................................. If applicant is a corporate, signature of duly authorized officer -- ,. ............. _ ............................................ , ...................... Stre~ and N--.r ............ ~ ..................... ;.....a...:L ......................... ~.~T~.... ~ ~ ~ Munlct~ll~ ~ ~. u~ a~ ~c~ of~ ~~i~ a~ Int~ ~ ~y of p~ ~i~: ...................... ]]... b. Inte~ u, a~ ~c~ .~...~~ ..... ~~....'""'""...'"'"...'"..'" ....... 3. Nature of work (check which applicable): New Buildings,,.,..; ...... ; .... Addition .................. Alteration .................. Repair ..................~r~, .~ ~R~m°val .................. '"bem°l'lti°n: ~ :x::/~:~Ot~Y' Work (Describe) ........................................ ,. at m°ted .................. ............................................ (to be paid on filing this application) 5. If dwelling, number~ of dwelling units ............................ Number of dwelling,units on each floor ............................ If garage, number of cars ...................................................... ~ .......................... . ................................ '~['X".".";" ........ 6. If business, commercial or mixed occupancy, specify nature and extent of each ,type of use ............................ 7. D[rnensions of existing structures, if any: Front .......; .................... Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth [ ............................... Height ........................ 17~,~l~xumber of Stories .......... ?.~ .............. 8. Dimensions of entire new construction: Front ../j.~ ....... :~ ............... Rear ............................ Depth ........................ Height ..................../~'~Nun~ber of Storie~ .................................................... ~'~,~,~ .~..~}..~,~ ................................................. 9. Size of lot: Front ....4.....'::....:... .......... Rear ..'~....~ ~ ................... Depth ................... 10. Date of Purchase ........................................................ It~n'd af~m~ Owner ........................................................ /v 1 1. Zone or use district in which premise~ are situated ....~ .............................................. ~ ........................................ 12. Does proposed construction vic~t,e_~_ x~u~' ir .z ~.,,~°~,'ng~v'~rdinance or ~l/u,l~ ..................................................... 13. Name of Owner of premises ../..~.(~.~.::..Z?..~..~....~.Address ...../../,~.~..~....~.~.'. ............ Phone No ..................... Name of Architect ........ ~/~.......~.4J-.,J6..-J ............. Address. ...... ,~v....,~...~.....,,x .......... Phone No ..................... Name of ~,m,~yt.,/ ............................................. Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 1£7 ~OUN~ ~ ...~l.~.: ....... J ~' -- ~ ~.: ............................ ~~....' .........'....~~r ~.;..~. ...... ~ ....... ~'. ........... ~..~ ..... ~,.~ duly ~m, ~ a~ ~s ~ he is t~ applicant ~ (Na~ of individual signi~lic~ion) ~ /,) ~ r~ above namea. ~e is Tne ............................................ /.~. ......... .' ....... . ........... ,.. ...................................................... , ................. ~ (~ ~t, Co~mte officer, ~.) ~of ~id ~er or ownem, and is duly aut~riz~ to ~ or h~e pe~o~ ~e ~id ~ork a~ to ~e ~ file this applicati~; that all ~ateMents C~toin~ in this applic~i~ am tree tothe ~ of h~s ~l~ge a~ ~lief; and ~that the work will ~ pe~ormed in the manner ~t fo~ in the ~lic~i~ fil~ ~i~. ~ ~ Swomto~fom~is ~ ~ ~ A , ~ / . /~ ~ ................. ................... ......... , .... .......... ............................. ~ ~. ~IZAB~H ANN N~V~L~ ~ARY PUBLIC,~S~te ~w Y~ ~ARY PU8LIg, State 0f New Ye~ Ne. 52.8~5,. ~?ffnl~ ~0~ N~. 52-~[7850, Suffolk 0e~nty T~m Exp r:~ F,,n:ch 3], [g~ ........